Breaking bad news — the SPIKES protocol
Lesson 2 of 3 in Difficult Conversations — End-of-Life, Bad News, Family Meetings · 22 minutes
Bad news in healthcare follows specific patterns. The SPIKES protocol helps structure these difficult conversations. This lesson covers the technique and the practical application.
What you'll learn
- Apply the SPIKES protocol for breaking bad news
- Manage emotional responses with presence
- Coordinate with physician and family
- Follow up after difficult conversations
From the lesson
Healthcare regularly delivers bad news — diagnoses, prognoses, treatment failures, deaths. The SPIKES protocol (developed for oncology) structures these conversations. While physicians often lead, nurses are deeply involved — present during the conversation, supporting the patient and family, following up. This lesson covers the protocol and the nurse's role.
1. The SPIKES protocol
S — Setting: • Privacy. • Sit down. • Eye contact. • Family present if patient wants. • No interruptions. • Allow time.
P — Perception: • Ask what the patient/family already knows. • 'What have you been told?' • 'What do you understand?' • Establishes baseline; corrects misunderstandings.
I — Invitation: • Ask how…